New Australian study: High-flow oxygen therapy improves outcomes in infant bronchiolitis

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High-flow oxygen therapy given by nasal cannula to infants with bronchiolitis - a treatment that adds heat, humidity and extra pressure to the oxygen - can cut odds of treatment failure by nearly half compared to standard-flow therapy, according to a new Australian study, A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitisavailable in CINAHL Complete on CKN

The test, reported online March 21 in The New England Journal of Medicine, was done on 1,472 babies less than a year old who were being treated outside the intensive care unit and were judged to need supplemental oxygen therapy.

While 23% in the standard-care group required an escalation of care, the rate was only 12% in the high-flow population (P<0.001).

And among the infants who were switched to the high-flow group because conventional treatment wasn't preventing persistent tachycardia, hypoxemia or other problems, 61% responded to the switch.

Chief author Dr. Andreas Schibler, a paediatric intensive care specialist at Lady Cilento Children's Hospital and The University of Queensland, said clinicians were so impressed by what they saw in the study, which was not blinded, they immediately began using high-flow treatment outside the trial.

However, high-flow therapy did not affect other metrics, such as intensive care unit admission (ICU), duration of hospital stay, or duration of oxygen therapy.

Hospitalisation costs for bronchiolitis will cost the Australian health system upwards of $30 million per year

In infants, the usual therapy includes 100% oxygen for hypoxemia delivered through a nasal cannula at 2 litres per minute. High-flow oxygen therapy includes heating and humidifying the oxygen and extra pressure.

The Schibler team estimated that 9 infants would need to be treated to prevent one case where the escalation of therapy would be necessary.

The benefits of high-flow therapy were seen both in hospitals that had an on-site ICU and those that did not.

In facilities without an ICU, escalation of care occurred in 7% of babies getting high-flow therapy versus 28% of those who did not. When there was an on-site ICU, the rates were 14% and 20%, respectively.

Dr. Schibler said a follow-up study is underway to examine whether the benefits are comparable in children ages 1 to 4.

High-flow treatment costs about $80 to $120 in Australia, depending on the setup, he said. "But that's offset by the avoidance of ICU admission."

"The other question is, is this a treatment that could help children in under-resourced countries," said Dr. Schibler. "It's so quick, and cheap, and easy to use. The use in under-resourced countries is part of the potential."